Study finds 'alarming' resistance levels in neonatal sepsis in India

Nick Cunard, DFID / Flickr cc

Nick Cunard, DFID / Flickr cc

A new study has found that sepsis accounts for nearly a quarter of newborn deaths in India, with most episodes occurring within 3 days of birth. The study also found that the infecting pathogens are marked by an alarming degree of antimicrobial resistance.

The results come from the Delhi Neonatal Infection Study, a prospective cohort study of more than 88,000 live births recorded at three tertiary care hospitals in New Delhi from July 2011 to February 2014. The study was published in the Lancet Global Health.

From those 88,636 live births, 13,530 newborns were enrolled in the study after admission to a neonatal intensive care unit (NICU), and 1,934 received a final diagnosis of sepsis. The incidence of total sepsis was 14.3%, and nearly two-thirds of cases occurred within 72 hours of birth. Sepsis was the underlying cause of death in 24% of the enrolled newborns who died during the study.

Sepsis occurs when the body has an immediate, systemic, and overwhelming reaction to an infection. It most often occurs in people older than 65 or under age 1 and in patients with weakened immune systems or chronic medical conditions like diabetes. According to the study, sepsis is one of the three most common causes of neonatal deaths globally.

While most infection-related deaths in the neonatal period occur in low- and middle-income countries like India, up until now there data have been lacking on neonatal sepsis rates in these countries. The authors say this lack of data has prevented public health officials in India from recognizing neonatal sepsis as an area of serious concern and implementing measures to prevent it.

High rates of multidrug resistance

In addition to the high rate of sepsis observed, the authors were also surprised by the level of antimicrobial resistance they found among the infected newborns. Analysis of clinical isolates found that 64% were gram-negative bacteria, with Acinetobacter spp (22%) being the most common, followed by Klebsiella (17%) and Escherichia coli (14%).

High rates of multidrug resistance were observed in all three pathogens, with 82% of Acinetobacter isolates, 54% of Klebsiella isolates, and 38% of E coli isolates displaying resistance both to commonly used antibiotics and more sparingly used extended-spectrum cephalosporins and carbapenems.

According to an accompanying commentary, estimates indicate that 56,524 newborns in India die each year from bacteria that are resistant to first-line antibiotics.

While the death rate of sepsis caused by resistant pathogens was only slightly higher than that of sepsis caused by susceptible pathogens, the authors noted their findings add to concerns about the spread of antimicrobial resistance in India—where antimicrobial prescribing is high—and what it could mean for the future of neonatal care in the country's hospitals. "The high rates of multidrug resistance…in the three common Gram-negative bacteria threaten the return of preantibiotic era in Indian NICUs," they wrote.

"Our study highlights the need to undertake research to understand the pathogenesis of early-onset sepsis and to devise measures to prevent related morbidity and mortality," the authors concluded. "The findings also serve as a yet another wake-up call for global action to curb the escalating menace of antimicrobial resistance."

See also:

Sep 13 Lancet Glob Health study

Sep 13 Lancet Glob Health commentary

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